[Severe postoperative complications in colorectal surgery for cancer. Incidence related to the techniques employed: open versus laparoscopic colectomy]

Abstract

In this preliminary retrospective study, severe postoperative complications following surgery for colorectal cancer were analysed, comparing the results obtained with open versus laparoscopic colectomy. Over the period 2005-2007, 50 patients (29 female, 21 male; age range: 32-85 years) underwent surgical treatment for colorectal-anal cancer. Twenty-nine (58%) were submitted to the traditional open technique and 21 (42%) to the laparoscopic technique. No mortality occurred with either technique. None of the cases submitted to laparoscopy presented anastomotic dehiscence or severe intraoperative bleeding. In the group submitted to open surgery, 3 cases of severe complications occurred (10.3%), consisting in acute faecal peritonitis due to immediate dehiscence of the colorectal anastomosis; angulation of the intestinal loop with microdehiscence of the ileo-colic anastomosis; and pulmonary embolism. In the group submitted to laparoscopic surgery, 2 cases of severe complications occurred (9.5%), consisting in enterorrhagia due to haemoperitoneum; and intrafascial haematoma due to haemorrhage of the epigastric artery. The overall complication rate was 10%, corresponding to the minimum values reported in the literature. No statistically significant difference was observed in the incidence of these complications with the two methods employed. A very low incidence of minor complications was observed, limited to repercussions on the postoperative course. Furthermore, the laparoscopic technique led to early canalisation, a reduction in hospital stay, less need of drugs (antibiotics and pain killers) and better aesthetic results. The advantages obtained with the laparoscopic technique, with no significant differences in severe complications, indicate that this approach is preferable to the traditional technique in colorectal surgery for cancer.